This paper examines the emergence of a particular rhetoric in bioethics that defines how specific ethical problems are to be understood, communicated, and sometimes resolved. Because bioethics is in its most public forms an advisory agent (e.g., in government commissions), its pronouncements about such ethical problems have no binding authority except in limited forms, such as in the function of institutional review boards. For the past half century, this role has cast the bioethicist as “above the fray.” “Above the fray” is fraught with contradictions as it pertains to highly contested medical-ethical matters such as abortion and euthanasia.

In considering how to approach contested matters that have spilled out beyond the academic and think-tank confines of debate and discussion, some bioethicists have acknowledged that these matters inevitably implicate political positions and perspectives. Ruth Macklin in several respects raised the ante on what politics may have to do with bioethics with her open and sustained criticisms of Leon Kass and his work as Chairman of the President’s Council on Bioethics in the early years of 2000 as well as of contributors to the journal, The New Atlantis. She criticized the claims of “conservative bioethics” while defining herself (and clearly others whom she referred to as “mainstream”). This was an unprecedented move to develop contrasts between so-called liberals and so-called conservatives about the most effective approaches to reducing human suffering.

For Macklin and mainstream bioethicists, what underlies their rhetoric of suffering is a strong belief in progress as it enables a greater achievement of justice for those who suffer from life’s many forms of inequality. She is keen to acknowledge that mainstream bioethicists disagree on a host of matters, but she stops short of explaining why these disagreements receive much less public attention than those mounted by conservatives. By defining oneself as “mainstream,” thus seeing oneself as running between various tributaries of dissent that flow in openly political directions, whether left or right, the unspoken discontent may really be about not being taken seriously in the role of expert advisor. ​Macklin admits that her hope for bioethics is focused on matters of justice “in access to health care and the gap in the health status between rich and poor, as well as broader issues of global justice in medical research and health disparities between industrialized and developing countries.” Here is stated an agenda on the reduction of suffering around the world that is compared to the absence of such concerns among alleged conservatives who are labeled as fatalists and who are said to be opposed to a variety of medical and technical interventions. The reduction of suffering under Macklin’s guidance is clearly a political project, historically undertaken by public agencies, charities, and schools of public health who were pioneers in the strategies to combat both infectious and non-infectious diseases across the globe. There is, then, a profound bifurcation in the perceptions of what constitutes moral thinking in bioethics about the matter of suffering.